1) How do I get medical treatment once my contribution has started deducted ?
2) How do I get hospital treatment ( OPD/Indoor) ?
3) How do I get Ayurvedic Treatment ?
4) What should I do in emergency ?
5) How do I get Advance Payment or Reimbursement.?
6) How do I get Cash Benefit ? The procedural Aspect
7) How do I get medical treatment once my contribution has started deducted ?

Each person after joining insurable employment , after completing certain formality , is issued an identity card which has all essential particulars i.e. name , insurance no. of the IP , dispensary and local office to which he is attached and names of his/her family members. This card is a very important document and has to be produced while obtaining medical benefits.

A beneficiaries can claim treatment at the dispensary/clinic of the IMP to which he/she is allotted on the production of the card.

How do I get hospital treatment ( OPD/Indoor) ?

To claim specialists consultation and/or indoor treatment at an ESIS institution or a hospital where arrangement has been made for the ESIS beneficiaries.The concerned doctor of the allotted dispensary refer him/her to that hospital with necessary prescribed forms.

How do I get Ayurvedic Treatment ?

For aurvedic treatment a separate case of ayurved has to be obtain from the case counter. Aurvedic Medical Officer will prescribed the ayurvedic treatment after examining the patient. If required Auy. Medical Officer will refer the patient to any of the following hospital of Ahmedabad for specialist consultation.

· Panchkarma & Kharsutra unit , Bapunagar General Hospital, Ahmedbad.

· Akhand Anand Ayurved Hospital , Ahmedabad.

· Maniben Ayurvedic Hospital , Ahmedabad.

· Vivekanand Ayurvedic Hospital , Ahmedabad.

The patient the dispensary where there is no post of the Ayurvedic Medical Officer first obtain the case of the his/her dispensary and then go to nearby dispensary. There he/she should again get a new case paper of that dispensary and get the treatment of the Ayruved there,

What should I do in emergency ?

Usualy in case of emergency , a beneficiary should report to the those State Insurance dispensaries/ hospitals where arrangement to provide emergency treatment have been made.

How do I get Advance Payment or Reimbursement.?

For obtaining Superspeciality treatment first of all Insurred person or his/her family member should go to his/her registered dispensary or penal doctor ( IMP) for primary examination.

Doctor of the dispensary after examining the patient fill up the form no. 4 (or form no 22 in emergency ) to refer to the concern super specialily facutly.

For establishing eligibility of the treatment Insured Person should obtain the Form No. 37 from the his/her occupational place, endorsed by the his/her local office and then submitted to the his/her dispensary.

Treatment prescribed by the specialist on Form no 4 or Form No. 22 of the referred patient will be provided.

Any extra amount to be required to be spend after the treatment of the then patient should contact Liaison Officer at Room No. 70 of Civil Hospital , Ahmedabad ,

If Insured Person want to bear the extra expenditure by his/her own then he/she should take the permission of the Assistant Director Medical Servicers (ADMS) of his/her region.

If Insured person wants payment in advance for this extra expenditure he/she should Apply in written to the Incharge Medical Officer of his/her dispensary furnishing following documents.

· Application regarding obtaining the advance payment.

· Copy of ESIC 37

· Form no. 4 of Form No. 22 showing detail of the treatment prescribed by the specialist.

· In case of family member certificate of dependency on Insured Person.

· Other required documents and Document as per instruction of the Incharge Medical Officer.

If Insured Person has bear the expenditure of his own he/she should apply in written for reimbursement with in one year to the Incharge Medical Officer of his/her dispensary furnishing following documents.

· Application regarding reimbursement.

· Copy of ESIC 37

· Form no. 4 of Form No. 22 showing detail of the treatment prescribed by the specialist.

· In case of family member certificate of dependency on Insured Person.

· Receipt of the institute that Insured Person had paid.

· All the prescription of the drugs and instrument as well as bill.

· Copy of the Discharge Card.

· Other required documents and Document as per instruction of the Incharge Medical Officer.

Once advance payment or reimbursement is passed the Insured Person will be informed and he/she will get the cheque though the Incharge Medical Officer. In case of Advance Payment the Concern Treatment giving organization will get the cheque and Insured Person or his/her family member can take the super speciality treatment for the organization without paying any extra.

How do I get Cash Benefit ? The procedural Aspect.

Cash benefits are distributed by the corporation xxxxx local office to an eligible IP on production of medical certificates given by the Medical officer of the dispensaries as per section 52 of the ESI Act.s

I would like to request Mr.Sideshwar and other members to post more views / experience about ESI problems enconcountered like Inspection, Penalties….& Solution found to problems like “Deleting records with words labour so as to avoid being penalized by ESI Officer for non compliance” & such other examples, so that in future budding managers of www.citihr.com would not have to face any kind of problems.

2) See penalities block in enclosed file. All penalities are the benefits for employer. If employees are getting benfits under ESI ,means their moral, loyality, productivity etc.. will be high that is benefit of employer.

I think answer of ur questn. is complete, if still any query u may pls write me.

Note: Pls file in the form of "pdf" so pls right click and "save target as" in ur pc and then open it.

Regards
Sidheshwar

Attached Files

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If an employee who is covered under ESIC got expired after working 8 months and if he did not submitted his Declaration Form his card has not been obtained but his deduction was made from his salary as well as the same has been deposited. Please let us know whether he is eligible for claim under ESIC or not.

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